Aim To describe diabetes nurses' perspectives on the impact of the COVID‐19 pandemic on people with diabetes and diabetes services across Europe. Methods An online survey developed using a rapid Delphi method. The survey was translated into 17 different languages and disseminated electronically in 27 countries via national diabetes nurse networks. Results Survey responses from 1829 diabetes nurses were included in the analysis. The responses indicated that 28% (n = 504) and 48% (n = 873) of diabetes nurses felt the COVID‐19 pandemic had impacted ‘a lot’ on the physical and psychological risks of people with diabetes, respectively. The following clinical problems were identified as having increased ‘a lot’: anxiety 82% (n = 1486); diabetes distress 65% (n = 1189); depression 49% (n = 893); acute hyperglycaemia 39% (n = 710) and foot complications 18% (n = 323). Forty‐seven percent (n = 771) of respondents identified that the level of care provided to people with diabetes had declined either extremely or quite severely. Self‐management support, diabetes education and psychological support were rated by diabetes nurse respondents as having declined extremely or quite severely during the COVID‐19 pandemic by 31% (n = 499), 63% (n = 1,027) and 34% (n = 551), respectively. Conclusion The findings show that diabetes nurses across Europe have seen significant increases in both physical and psychological problems in their patient populations during COVID‐19. The data also show that clinical diabetes services have been significantly disrupted. As the COVID‐19 situation continues, we need to adapt care systems with some urgency to minimise the impact of the pandemic on the diabetes population.

Purpose Although preeclampsia (PE) is a well-established cardiovascular risk factor (CVRF) in the general population, its role in type 1 diabetes (T1D) has been scarcely studied. We assessed the association between PE and preclinical atherosclerosis in T1D. Methods We recruited 112 women without cardiovascular disease and last pregnancy ≥5 years before: (1) T1D and previous PE (T1D+/PE+; n = 28); (2) T1D without preeclampsia (T1D+/PE–; n = 28); (3) previous PE without T1D (T1D–/PE+; n = 28); and (4) controls (without T1D or PE; T1D–/PE–; n = 28). Groups were matched by age, several CVRFs, and diabetes duration and retinopathy (in T1D participants). Carotid intima-media thickness (IMT) and the presence of plaque (IMT ≥ 1.5 mm) were assessed by standardized ultrasonography protocol. Results Mean age of the participants was 44.9 ± 7.8 years (14.3% hypertension and 21.4% active smokers). Groups including T1D (T1D+/PE+ and T1D+/PE–) more frequently presented hypertension and statin treatment (23.2% vs 5.4% and 37.5% vs 8.9%; respectively; P < 0.01), without differences in other CVRFs. Carotid plaques were observed in 20.5%. In multivariate models adjusted for age, CVRF, and statins, both T1D and PE showed a similar impact on the presence of plaque, with odds ratios (95% confidence interval), 5.45 (1.36–21.9) and 4.24 (1.04–17.3), respectively. Both entities showed an additive effect when combined, both in common carotid-IMT (T1D+/PE– or T1D–/PE+, β = 0.198; T1D+/PE+, β = 0.297) and in the presence of plaque (8.53 [1.07–68.2] and 28.1 [2.67–296.4], respectively). Conclusions Previous PE was independently associated with preclinical atherosclerosis in T1D. Further studies are needed to ascertain its usefulness for stratifying risk in T1D women.

AimsPersistence of lipoprotein abnormalities in type 1 diabetes (T1D) and/or pre‐eclampsia could be associated with cardiovascular disease (CVD). We assessed differences in the advanced lipoprotein profiles according to the presence of both conditions and their differential association with atherosclerosis.Material and methodsWe recruited 112 women without CVD and last pregnancy ≥5 years previously, divided into four groups (n = 28 per group): (a) T1D and previous pre‐eclampsia; (b) T1D without pre‐eclampsia; (c) pre‐eclampsia without T1D; and (d) controls (without T1D/pre‐eclampsia). Groups were matched by several risk factors, and diabetes duration and retinopathy in T1D. Carotid intima‐media thickness (IMT) and the presence of plaque (IMT ≥1.5 mm) were assessed by ultrasonography. The lipoprotein profile was evaluated by nuclear magnetic resonance (NMR) spectroscopy.ResultsThe participants were 44.9 ± 7.8 years old. Carotid plaque presence was 20.5%, with a higher prevalence in T1D and/or pre‐eclampsia vs controls (P < .05). High‐density lipoprotein (HDL)‐related variables differed among groups, mainly driven by an increase in T1D (P < .05), whereas triglyceride‐related variables were increased in pre‐eclampsia [medium very low‐density lipoprotein (VLDL) particles and triglyceride enrichment in HDL and low‐density lipoprotein (LDL)]. Overall, in multivariate‐adjusted models, LDL‐related variables were the most strongly associated with atherosclerosis (P < .05). In age‐ and statin‐adjusted models, previous pre‐eclampsia showed an independent association with triglyceride‐related variables (plaque: medium‐VLDL‐particles, OR 1.550 [1.013‐2.374]; HDL‐cholesterol/HDL‐triglycerides ratio, OR 0.411 [0.175‐0.967]). Regarding T1D, HDL‐parameters were also differentially associated (maximum‐IMT: HDL‐cholesterol/HDL‐particles ratio, β = −.258, P = .036).ConclusionsNMR lipoproteins were differentially and independently associated with atherosclerosis in T1D/pre‐eclampsia. Further studies are needed to ascertain the role of NMR parameters as CVD biomarkers in this high‐risk population.

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